title: Bone protection and anti-epileptic drugs: the effect of audit and computer messaging on supplementation prescribing practices.
abstract: OBJECTIVE
  This audit assessed the impact of individualised written recommendations and a computer message, on repeat prescriptions for calcium and vitamin D supplements, for patients on long term AEDs.
  
  
  METHODS
  1041 adult patients with epilepsy were retrospectively followed from 2004, from the time of the introduction of the Quality and Outcomes Framework (QOF) and the publication of the National Institute of Clinical Evidence (NICE) guidelines for epilepsy, up until 2011. In 2009 a clinical notes review of 414 of the above patients, in Ellesmere Port and Neston (13 practices) was performed, suggesting supplementation, where appropriate, in a written report. A computer message was added to relevant prescriptions also recommending supplements, in the above practices plus all 26 practices in Chester and the surrounding area. The number of patients receiving repeat prescription for supplements in each area between 2004 and 2011 was analysed.
  
  
  RESULTS
  There was a significant increase in the repeat prescriptions of supplements in 2010/11 after the interventions, the increase being most marked in Ellesmere Port and Neston where both written recommendations and computer message had occurred compared with the two areas with the computer message only.
  
  
  CONCLUSIONS
  Quality audit with written recommendations, and a message added to the General Practice (GP) computer systems significantly increased the number of repeat prescriptions of calcium and vitamin D supplements in this group of patients.
  
  
  CONCLUSIONS
  Where clear guidelines are established, this study demonstrates that continuing education and counselling of GPs and use of computer messaging would result in improved compliance with such guidelines.
authors.affiliation: Northgate Village Surgery, Northgate Avenue, Chester CH2 2DX, United Kingdom. Electronic address: ian.minshall@nhs.net.
authors.forename: I
authors.initials: I
authors.lastname: Minshall
authors.forename: M
authors.initials: M
authors.lastname: Mahon
authors.forename: A
authors.initials: A
authors.lastname: Neligan
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D001847:Bone Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D002118:Calcium / Q000008:administration & dosage; D016208:Databases, Factual / Q000706:statistics & numerical data; D019587:Dietary Supplements; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D014807:Vitamin D; D002118:Calcium
keywords: Audit; Calcium and vitamin D; Epilepsy; Primary care